背景:在美国,50岁之前诊断出的子宫癌正在增加,但以前没有描述不同种族/族裔群体的临床特征和生存率随时间的变化.
目的:调查年龄调整后,子宫切除术纠正发病率和趋势,50岁以下女性子宫癌的五年相对生存率,整体和按种族/民族和组织学分层。
方法:我们纳入了监测中20-49岁女性的显微镜下证实的子宫癌病例(诊断为2000-2019年),流行病学,和最终结果计划(SEER22)。年龄调整后的发病率和5年相对生存率,95%置信区间使用SEER*Stat计算,并在各个时间段(2000-2009年和2010-2019年)进行比较。使用行为危险因素监测系统数据调整子宫切除术的发生率,并使用Joinpoint回归程序计算趋势。
结果:我们包括57,128例子宫癌病例。子宫癌的发病率从2000-2009年的10.1/10万增加到2010-2019年的12.0/10万,整个时期的年增长率为1.7%/年。在40岁以下的女性中,上升趋势更为明显(20-29岁和30-39岁的3.0%/年和3.3%/年,分别)比这40-49年(1.3%/年),在代表性不足的种族/族裔群体中(西班牙裔2.8%/年,非西班牙裔,[NH]-黑色2.7%,NH-亚洲/太平洋岛民[PI]2.1%)比NH-怀特(0.9%/年)。最近(2010-2019年)子宫内膜样瘤的发病率最高(9.6/10万),其次是肉瘤(1.2),和非子宫内膜样亚型(0.9)。从2000年至2019年,子宫内膜样亚型的比率显着增加,为1.9%/年。最近子宫内膜样和非子宫内膜样率在NH-美国原住民/阿拉斯加原住民[NA/AN]中最高(15.2和1.4/100,000),其次是西班牙裔(10.9和1.0),NH-亚洲/PI(10.2和0.9),NH-White(9.4和0.8),和最低的NH-黑人妇女(6.4和0.8)。NH-黑人女性的肉瘤发生率最高(每100,000人中有1.8人)。子宫内膜样(从2000-2009年的93.4%到2010-2019年的93.9%,p≥0.05)和非子宫内膜样亚型(从73.2%到73.2%,p≥0.05),但肉瘤女性从69.8%(2000-2009年)降至66.4%(2010-2019年,p<0.05)。
结论:从2000年到2019年,<50岁女性的子宫癌发病率有所增加,而生存率保持相对不变。发病率趋势可主要归因于子宫内膜样组织学癌症的发病率增加。在NH-Black中观察到最大的增加,西班牙裔,和NH-Asian/PI。肉瘤,虽然更罕见,是<50岁女性中第二常见的子宫癌类型,预后较差,随着时间的推移生存率明显下降。50岁以下妇女中子宫癌发病率的上升和独特的流行病学模式凸显了该年龄组子宫癌有效预防和早期检测策略的必要性。
BACKGROUND: Uterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described.
OBJECTIVE: To investigate age-adjusted, hysterectomy corrected incidence rates and trends, and five-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology.
METHODS: We included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20-49 years from the Surveillance, Epidemiology, and End Results Program (SEER 22). Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using SEER*Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program.
RESULTS: We included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/year for the entire period. Rising trends were more pronounced among women <40 years (3.0%/year and 3.3%/year in 20-29 and 30-39 years, respectively) than in those 40-49 years (1.3%/year), and among underrepresented racial/ethnic groups (Hispanic 2.8%/year, Non-Hispanic, [NH]-Black 2.7%, NH-Asian/Pacific Islander [PI] 2.1%) than in NH-White (0.9%/ year). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and non-endometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/year from 2000-2019. Recent endometrioid and non-endometrioid rates were highest in NH-Native American/Alaska Native [NA/AN] (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), NH-Asian/PI (10.2 and 0.9), NH-White (9.4 and 0.8), and lowest in NH-Black women (6.4 and 0.8). Sarcoma rates were highest in NH-Black women (1.8 per 100,000). The five-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, p≥0.05) and non-endometrioid subtypes (from 73.2% to 73.2%, p≥0.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, p<0.05).
CONCLUSIONS: Uterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among NH-Black, Hispanic, and NH-Asian/PI. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.